'Clinically unnecessary' use of emergency and urgent care: A realist review of patients' decision making

Background

Demand is labelled ‘clinically unnecessary’ when patients do not need the levels of clinical care or urgency provided by the service they contact.

Objective

To identify programme theories which seek to explain why patients make use of emergency and urgent care that is subsequently judged as clinically unnecessary.

Design

Realist review.

Methods

Papers from four recent systematic reviews of demand for emergency and urgent care, and an updated search to January 2017. Programme theories developed using Context‐Mechanism‐Outcome chains identified from 32 qualitative studies and tested by exploring their relationship with existing health behaviour theories and 29 quantitative studies.

Results

Six mechanisms, based on ten interrelated programme theories, explained why patients made clinically unnecessary use of emergency and urgent care: (a) need for risk minimization, for example heightened anxiety due to previous experiences of traumatic events; (b) need for speed, for example caused by need to function normally to attend to responsibilities; (c) need for low treatment‐seeking burden, caused by inability to cope due to complex or stressful lives; (d) compliance, because family or health services had advised such action; (e) consumer satisfaction, because emergency departments were perceived to offer the desired tests and expertise when contrasted with primary care; and (f) frustration, where patients had attempted and failed to obtain a general practitioner appointment in the desired timeframe. Multiple mechanisms could operate for an individual.

Conclusions

Rather than only focusing on individuals' behaviour, interventions could include changes to health service configuration and accessibility, and societal changes to increase coping ability.

A support package for parents of excessively crying infants: development and feasibility study

BACKGROUND

Around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason. Traditionally, this was attributed to gastrointestinal disorder ('colic'), but evidence shows that just 5% of infants cry a lot because of organic disturbances; in most cases, the crying is attributable to normal developmental processes. This has led to a focus on the impact of the crying on parents. Parental vulnerabilities influence how parents evaluate and respond to the crying and predict adverse outcomes. By developing evidence-based services that support parents, this study was designed to take the first steps towards national health services that enhance the coping and well-being of parents whose babies excessively cry. Related aims were to improve these infants' outcomes and how NHS money is spent.

OBJECTIVES

To develop a novel intervention package to support parents of excessively crying infants and to examine the feasibility of delivering and evaluating it in the NHS.

DESIGN

Stage 1 of this study aimed to (1) complete a literature review to identify example support materials, (2) obtain parents' guidance on the support needed when a baby cries excessively, together with their evaluation of the example materials, and (3) develop a support package based on the results. Stage 2 aimed to (1) recruit 60 parents whose babies were currently excessively crying, (2) assess parents' and NHS professionals' willingness to complete a study of the support package, (3) measure the use and evaluation of the package components, (4) estimate the package component costs and (5) provide evidence on the feasibility and methods for a large-scale trial.

SETTING

Primary health care.

PARTICIPANTS

Stage 1: 20 parents of previously excessively crying infants and 55 health visitors (HVs) or specialist community public health nurses (SCPHNs). Stage 2: 57 parents of currently excessively crying infants and 124 HVs/SCPHNs.

INTERVENTIONS

The support package included a website, a printed booklet and a programme of cognitive-behavioural therapy-based sessions delivered to parents by a qualified practitioner.

MAIN OUTCOME MEASURES

(1) Demographic data, (2) figures for parents' use of the package components and continuation in the study, (3) parents' and HVs'/SCPHNs' ratings of the package components and suitability for NHS use, (4) questionnaire measures of parental well-being and infant health and (5) costs.

RESULTS

Most parents (95%) accessed the website or printed materials and half (51%) attended the practitioner sessions. All 52 parents and 85% of HVs/SCPHNs providing data would support the inclusion of the package in the NHS. It was associated with reduced parental frustration, anxiety, depression, reported infant crying and contacts with health professionals and increased knowledge about crying. Methods for a full trial and figures for the cost of excessive infant crying for the NHS and each package element were identified.

LIMITATIONS

No control group was included. Most of the recruited parents were white, well educated and in stable relationships.

CONCLUSIONS

Parents and HVs/SCPHNs recognise the need for NHS provisions that support parents of excessively crying babies and consider the materials developed to meet that need. A full-scale randomised controlled trial is feasible and desirable.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN84975637.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 56. See the NIHR Journals Library website for further project information.

Parental and health professional evaluations of a support service for parents of excessively crying infants

Background

The ‘Surviving Crying’ study was designed to develop and provisionally evaluate a support service for parents of excessively crying babies, including its suitability for use in the United Kingdom (UK) National Health Service (NHS). The resulting service includes three materials: a website, a printed booklet, and a Cognitive Behaviour Therapy (CBT) programme delivered to parents by a qualified professional. This study aimed to measure whether parents used the materials and to obtain parents’ and NHS professionals’ evaluations of whether they are fit for purpose. Parents were asked about participating in a randomised controlled trial (RCT) to evaluate the materials fully in health service use.

Methods

Participants were 57 parents with babies they judged to be crying excessively and 96 NHS Health Visitors (HVs). Parental use and parents’ and HVs’ ratings of the Surviving Crying materials were measured.

Results

Thirty four parents reported using the website, 24 the printed booklet and 24 the CBT sessions. Parents mostly accessed the website on mobile phones or tablets and use was substantial. All the parents and almost all HVs who provided data judged the materials to be helpful for parents and suitable for NHS use. If offered a waiting list control group, 85% of parents said they would have been willing to take part in a full RCT evaluation of the Surviving Crying package.

Discussion and conclusions

The findings identify the need for materials to support parents of excessively crying babies within national health services in the UK. The Surviving Crying support package appears suitable for this purpose and a full community-level RCT of the package is feasible and likely to be worthwhile. Limitations to the study and barriers to delivery of the services were identified, indicating improvements needed in future research.

Trial registration

Study Registration no. ISRCTN84975637.

Development of a tool to support managers in planning and evaluating staff training

AIM

To explore decision-making and evaluation strategies used by healthcare managers in relation to staff training and education, and to develop a tool to support managers with these tasks.

METHOD

Using snowball sampling, 30 healthcare managers in a variety of healthcare settings were recruited and interviewed using semi-structured interviews. Data were transcribed and analysed using thematic analysis.

FINDINGS

Four overarching themes were identified in relation to decision-making regarding staff training: the nature and characteristics of courses relevant to practice; the effect of practice requirements for education and training; staff motivation and interest; and the process of staff selection for training. Managers did not use formal, structured processes to make decisions about staff selection for training, nor to evaluate the outcomes of the training. Instead, they largely relied on their personal experience, knowledge and professional judgements. Based on these findings, the study team developed the Assessment, Planning and Evaluation of Training (APET) tool to support the planning and evaluation of training, and they invited feedback from healthcare managers. Positive feedback suggests that this tool could support managers' decision-making in relation to planning and evaluating staff training.

CONCLUSION

Healthcare managers' decision-making in relation to the planning and evaluation of staff training relied on judgements based on their personal experience and knowledge. The APET tool developed by the study team has the potential to ensure vital resources such as time and money are used optimally, which would improve outcomes for staff, patients and healthcare organisations.

Expression of programmed death ligand-1 and programmed death 1 in hepatocellular carcinoma and its clinical significance

Objective

To investigate the correlation between the expression of programmed death 1 (PD-1) and PD ligand-1 (PD-L1) in hepatocellular carcinoma (HCC) and clinical parameters.

Materials and Methods

The study comprised tumor sections from 45 HCC patients treated with curative resection, which were evaluated for PD-1 and PD-L1 protein expression by immunohistochemistry.

Results

PD-1 and PD-L1 expression was increased in cancers compared to adjacent normal tissues, with a positive rate of 37.78% (17/45) and 62.22% (28/45), respectively, which was positively correlated with the tumor stage and lymph node metastasis, negatively with postoperative prognosis. PD-1 positivity was most frequently observed in stromal tumor-infiltrating lymphocytes. The number of PD-1 positive lymphocyte was correlated with PD-L1 positive expression.

Conclusion

PD-L1 and PD-1 are overexpressed in HCC tissues. PD-L1 expression plays a critical role in the pathogenesis of human HCC, suggesting that it might be used as a new biomarker to predict the disease progression and prognosis.

CRISPR/Cas9-mediated disruption of the immediate early-0 and 2 as a therapeutic approach to Bombyx mori nucleopolyhedrovirus in transgenic silkworm

The CRISPR/Cas9 system is a powerful tool for the treatment of infectious diseases. In our previous study, we knocked out the Bombyx mori nucleopolyhedrovirus (BmNPV) key genes and BmNPV-dependent host factor to generate transgenic antiviral strains. To further expand the range of target genes for BmNPV and more effectively prevent and control pathogenic infections, we performed gene editing and antiviral analysis by constructing a target-directed baculovirus early transcriptional activator immediate early-0 (ie-0) and 2 (ie-2) transgenic silkworm line. We hybridized it with Cas9 transgenic line to produce a double-positive transgenic Cas9(+)/sgIE0-sgIE2(+) line that could activate the CRISPR gene editing system. We first demonstrated that the system is capable of efficiently editing target genes and resulting in fragment deletions in the BmNPV genome. Survival rate of the transgenic Cas9(+)/sgIE0-sgIE2(+) line reached 65% after inoculation with 1 × 10⁶ occlusion bodies/larva. Molecular analysis showed that BmNPV DNA replication and viral gene expression level in the transgenic Cas9(+)/sgIE0-sgIE2(+) line were significantly inhibited compared with the control Cas9(-)/sgIE0-sgIE2(-) line. These results indicated that IE-0 and IE-2, as baculovirus early transcriptional activators, can be used as target sites for gene therapy and that multigene editing could expand the range of target sites for research to create silkworm resistance breeds.

Cathepsin L is involved in proliferation and invasion of breast cancer cells

Cathepsin L(CTSL), a lysosomal endopeptidase was found overexpressed in Breast cancer (BC). The purpose of this work was to investigate the possible role of CTSL in the development of BC. RNA interference(RNAi) with a CTSL small hairpin RNAs(CTSL-shRNA) and plasmid with CTSL were used to identify the effects of CTSL on malignant behaviors of BC. MCF-7 and SKBR-3 were selected as cell models in vitro and in vivo. The results showed that down-regulation of CTSL can significantly inhibit the proliferative and invasive ability of MCF-7 cell, while up-regulation of CTSL in SKBR-3 cells had opposite effects. Comparing to parental BC cells, CTSL knockdown cells exhibited attenuated capacities in developing tumor in nude mice, furthermore, the growth of these xenografts were dramatically regressed. In conclusion, our findings suggest that CTSL contributes to the proliferation and metastasis of BC and might be a potent molecular target for BC treatment.

Preventing secondary exposure to women from men applying a novel nestorone/testosterone contraceptive gel

BACKGROUND

Testosterone (T)/Nestorone (NES) combination gel is a potential transdermal male contraceptive that suppresses gonadotropins and spermatogenesis. Transfer of transdermal T from men to women can be prevented by washing or covering application sites with clothing.

OBJECTIVES

We hypothesized that showering or wearing a shirt over gel application sites would prevent secondary exposure of T and NES to a woman after close skin contact.

MATERIALS AND METHODS

Twelve healthy male and 12 healthy female participants were recruited. Men applied T/NES 62 mg/8 mg gel to their shoulders and upper arms. Two hours after application, female partners rubbed the application site for 15 min. Exposure in the female partner was assessed under three conditions: a shirt covered the application site; the man showered prior to skin contact; or without intervention to reduce transfer. Serum T and NES concentrations were measured by LC-MS/MS in serial blood samples for 24 h after gel exposure.

MAIN OUTCOMES

Change in female serum T and NES levels as measured by average concentration over 24 h (C_avg ).

RESULTS

Median female serum T C_avg was 23.9 ng/dL (interquartile range, 19.3, 33.9) with the shirt barrier and 26.7 ng/dL (20.7, 33.9) after showering, which was higher than baseline 20.9 ng/dL (16.7, 25.0), both p < 0.03) but lower than without intervention (58.2 ng/dL [30.9, 89.1], both p < 0.01). Female serum NES C_avg and maximum concentration were below the lower limit of quantification with the shirt barrier and after showering, but increased without intervention in six of 12 women (maximum concentration <60 pg/mL). Men had lower average serum NES levels after showering (47 pg/ml [20, 94] compared to no intervention (153.3 pg/mL [51, 241], p < 0.02).

CONCLUSION

Secondary transfer of T and NES occurs after intensive skin contact with the gel application site. Secondary transfer is decreased by a shirt barrier or showering before contact.

[Effects of hyperbaric oxygen on mucosal inflammatory response after nasal surgery in rabbits]

Objective:To observe the effect of hyperbaric oxygen therapy for the inflammation of rabbit nasal in postoperation period, to investigate the clinical feasibility of hyperbaric oxygen therapy in reducing the inflammatory reaction and promoting mucosal healing in nasal recovery stage after surgery.Method:A total of 16 Japanese white rabbits were randomly assigned to hyperbaric oxygen group and non hyperbaric oxygen group, with 8 in each, and another 5 was divided into normal control group. The non hyperbaric oxygen group was in the normal atmospheric environment, the hyperbaric oxygen group was given hyperbaric oxygen treatment on the fifth day after the operation. All the animals were sacrificed to observe the morphological changes and pathological changes of the mucosa in the bilateral inferior turbinate surgery area at sixth weeks after operation. The normal control group was taken the same part of mucosa.Result:Specimen: hyperbaric oxygen group postoperative empyema in 2 side, 8 side of non hyperbaric oxygen group, hyperbaric oxygen group was significantly reduced compared with non hyperbaric oxygen group, the difference was statistically significant (P< 0.05). Pathological changes: in the hyperbaric oxygen group, the infiltration of inflammatory cells was mild in 12 sides and moderate in 4 sides; the non hyperbaric oxygen group was mild in 1 sides, moderate in 13 sides, and severe in 2 sides, the hyperbaric oxygen group was significantly lower than the non hyperbaric oxygen group, the difference was statistically significant (P< 0.01).Conclusion:Under the condition of this experiment, hyperbaric oxygen therapy can significantly reduce the inflammatory response of rabbit nasal mucosa after operation, and reduce the accumulation of purulent secretion.

Increased serum periostin concentrations are associated with the presence of diabetic retinopathy in patients with type 2 diabetes mellitus

PURPOSE

To determine the association between serum periostin and the presence of diabetic retinopathy (DR).

METHODS

Serum periostin was detected in 114 healthy subjects, 122 patients with type 2 diabetes mellitus (T2DM) and 159 patients with DR and compared among groups. Clinical data and other laboratory measurements such as glycated hemoglobin (HbA1c), lipid profiles, serum creatinine (Cr) and high-sensitivity CRP (hsCRP) were also collected and compared among groups. For subgroup analysis, patients with DR were divided into a non-proliferated diabetic retinopathy (NPDR) group and a proliferated diabetic retinopathy (PDR) group. Multivariate analysis was performed using logistic regression models.

RESULTS

The serum periostin level was significantly higher in patients with diabetic retinopathy compared with healthy subjects and patients with T2DM (both P < 0.001, respectively). Also, the periostin level was significantly higher in the PDR group compared to the NPDR group (P = 0.044). Multivariate logistic regression revealed that serum periostin was independently associated with the presence of DR in patients with T2DM (P < 0.001). The receiver operating characteristic (ROC) curves for DR development using serum periostin showed that the area under the receiver operating characteristic curves (AUC) was 0.838 (P < 0.001).

CONCLUSIONS

The current study demonstrated that serum periostin is significantly associated with the presence of DR in patients with T2DM and is an independent risk factor of DR.

Overview of Systematic Reviews of Mindfulness Meditation-based Interventions for People With Long-term Conditions

Context • Increasing numbers of people worldwide live with a long-term health condition (LTC). Finding new ways to support people diagnosed with LTCs is important, both to improve their health-related quality of life and to manage the demands on health services that their conditions present. This effort includes a recognition of the importance of interventions to promote self-care. A growing number of systematic reviews of mindfulness meditation-based interventions (MMIs) for people with LTCs have been published but are diverse in scope and quality. Objectives • This systematic review of reviews aims to provide a critical overview of reviews evaluating studies using MMIs and to identify outcomes and conditions for which the clearest evidence exists for MMI effectiveness. Design • The Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Excerpta Medica dataBASE (EMBASE), Medline, PsycInfo, and Web of Science databases were searched in November 2013 for systematic reviews of MMIs for LTCs published since January 2005. Review selection and methodological quality assessment were subject to independent checking. Results • Of 3178 identified articles, 27 papers reporting on 26 reviews met the inclusion criteria. A substantially consistent picture emerged. Improvements in depressive disorders, particularly recurrent major depression, were strongly supported. Evidence for other psychological conditions was limited by lack of data. In populations with physical conditions, the evidence for significant improvements in psychological well-being was clear, regardless of population or specific mindfulness intervention. Changes in physical health measures were inconclusive; however, pain acceptance and coping were improved. Further research is needed to determine long-term and mindfulness-specific effects and to clarify the relationship between levels of mindfulness practice and outcomes. Conclusions • MMIs are potentially beneficial to people with depression and a range of long-term physical conditions, particularly in improving psychological well-being.

Mental health and well-being in parents of excessively crying infants: Prospective evaluation of a support package

BACKGROUND

During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well-being and mental health of parents who judge their infant to be crying excessively. The resulting "Surviving Crying" package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use.

METHODS

Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty-two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards.

RESULTS

Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep.

CONCLUSIONS

The findings suggest that the Surviving Crying package may be effective in supporting the well-being and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted.

Spatial self-organization resolves conflicts between individuality and collective migration

Collective behavior can spontaneously emerge when individuals follow common rules of interaction. However, the behavior of each individual differs due to existing genetic and non-genetic variation within the population. It remains unclear how this individuality is managed to achieve collective behavior. We quantify individuality in bands of clonal Escherichia coli cells that migrate collectively along a channel by following a self-generated gradient of attractant. We discover that despite substantial differences in individual chemotactic abilities, the cells are able to migrate as a coherent group by spontaneously sorting themselves within the moving band. This sorting mechanism ensures that differences between individual chemotactic abilities are compensated by differences in the local steepness of the traveling gradient each individual must navigate, and determines the minimum performance required to travel with the band. By resolving conflicts between individuality and collective migration, this mechanism enables populations to maintain advantageous diversity while on the move.

How bacteria migrate collectively despite individual phenotypic variation is not understood. Here, the authors show that cells spontaneously sort themselves within moving bands such that variations in individual tumble bias, a determinant of gradient climbing speed, are compensated by the local gradient steepness experienced by individuals.

Percutaneous CT-Guided Biopsies of the Cervical Spine: Technique, Histopathologic and Microbiologic Yield, and Safety at a Single Academic Institution

BACKGROUND AND PURPOSE

Cervical spine biopsies can be challenging due to the anatomy and the adjacent critical structures. Percutaneous image-guided biopsies can obviate the need for an open biopsy, however there have been few studies looking at the approaches, safety, and efficacy of percutaneous cervical spine biopsies. This retrospective study evaluated technical considerations, histopathologic and microbiologic yield, and safety in CT-guided cervical bone biopsies.

MATERIALS AND METHODS

A retrospective review of cervical bone and/or bone/disc biopsies performed from January 2010 to January 2017 was included in this study. Clinical diagnosis and indication, patient demographics, biopsy location, biopsy needle type, technical approach, lesion size, dose-length product, conscious sedation details, complications, and diagnostic histopathologic and/or microbiologic yield were recorded for each case and summarized.

RESULTS

A total of 73 patients underwent CT-guided cervical bone biopsies. Fifty-three percent (39/73) were for clinical/imaging concern for infection and 47% (34/73) were for primary tumors or metastatic disease. Thirty-four percent (25/73) were of the inferior cervical spine (ie, C6 and C7). A sufficient sample was obtained for histopathologic and microbiologic analyses in 96% (70/73) of the biopsies. Forty-six percent (18/39) of those samples taken for infection had positive cultures. Two intraprocedural complications occurred in which the patients became hypotensive during the procedure without long-term complications.

CONCLUSIONS

Percutaneous CT-guided biopsy of the cervical spine is an effective and safe procedure with high diagnostic yield and can obviate open procedures for histopathologic and microbiologic analyses of patients with clinical and imaging findings concerning for infection or primary and metastatic osseous lesions.

Treatment of hepatocellular carcinoma in the caudate lobe: US-guided percutaneous radiofrequency ablation combined with ethanol ablation

AIM

To evaluate the technical feasibility and treatment results of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) combined with ethanol ablation (EA) for hepatocellular carcinoma (HCC) in the caudate lobe.

MATERIALS AND METHODS

The institutional review board approved this retrospective study and the requirement for informed consent was waived. From October 2009 to June 2016, there were 49 patients with HCC in the caudate lobe underwent ablation. Among them, 14 patients (12 men and two women, mean age: 49.9±14.9 years) with 16 caudate lobe HCCs (mean size: 3±1.1 cm) who underwent US-guided RFA-EA were identified. These patients were compared with patients who underwent RFA alone (n=17) and EA alone (n=18).

RESULTS

HCCs in the RFA-EA group were larger than those in the EA-alone group (3±1.1 versus 2.1±0.7 cm, p=0.028). In the RFA-EA group, all the patients achieved treatment success (14/14) and entered follow-up. After a follow-up period of 17.1±10.6 months (range, 5-36 months), local tumour progression (LTP) was detected in four tumours. The 1- and 2-year LTP rates after RFA-EA were 18.8% and 27.8%, respectively. The 1- and 2-year disease-free survival (DFS) rates were 35.7% and 13.4%. Six patients died, with the 1-, 2-, and 3-year overall survival (OS) rates of 85.1%, 63.1%, and 21%, respectively. There were no significant differences in the LTP, DFS, and OS rates between the RFA-EA group and RFA-alone or EA groups (p=0.363-0.733).

CONCLUSION

US-guided percutaneous RFA-EA appears to be a feasible and effective treatment for HCC in the caudate lobe.

Plasma vascular endothelial growth factor B levels are increased in patients with newly diagnosed type 2 diabetes mellitus and associated with the first phase of glucose-stimulated insulin secretion function of β-cell

PURPOSE

To detect plasma vascular endothelial growth factor B (VEGF-B) in individuals with different glucose tolerance and investigate the relationship between plasma VEGF-B levels and the first phase of glucose-stimulated insulin secretion.

METHODS

A cross-sectional study was conducted involving 45 patients with newly diagnosed type 2 diabetes mellitus (T2DM), 37 patients with impaired glucose regulation (IGR), and 39 Normal glucose tolerance (NGT) subjects, all of whom underwent intravenous glucose tolerance test. Plasma VEGF-B levels were assayed by ELISA. The first phase of insulin secretion was evaluated by acute insulin response (AIR), the area under the curve of the first-phase (0-10 min) insulin secretion (AUC) and glucose disposition index (GDI).

RESULTS

The T2DM and IGR groups had higher plasma VEGF-B levels than the NGT group (P < 0.01). Plasma VEGF-B levels were negatively correlated with AIR, AUC, GDI, HOMA-β (P < 0.01), and positively correlated with plasma glucose, HbA1c, triglyceride, free fatty acid (FFA), fasting insulin, and HOMA-IR (P < 0.01). Logistic regression analysis revealed that higher VEGF-B levels [145.59-180.07 pg/ml, OR 3.55 (95% CI 1.05-12.02) and >180.07 pg/ml, OR 3.64 (95% CI 1.16-11.42)] were related to a greater probability of β-cell hypofunction, compared with low VEGF-B levels (<145.59 pg/ml). After adjusting for triglyceride or FFA, the association between VEGF-B levels and β-cell hypofunction disappeared (P > 0.05).

CONCLUSIONS

Our study provides evidence that plasma VEGF-B levels were higher in patients with newly diagnosed T2DM, and were strongly associated with glucose and lipid metabolism and the first-phase insulin secretion function of β-cells. VEGF-B may be involved in the mechanism of β-cell dysfunction in T2DM.